Download - Chest x ray pathology
Pathology of lung
NORMAL CHEST X-RAY L- Lung T- Trachea AK- Aortic Knob A- Ascending Aorta H- Heart R- Ribs P- Pulmonary Artery S- Spleen
CONSOLIDATION
Lobar or Segmental Density Air BronchogramNo Loss of Lung Volume
CONSOLIDATION Density in left lower
lung field Loss of left heart
silhouette Diaphragmatic
silhouette intact No shift of mediastinum Blunting of costophrenic
angle
CONSOLIDATION
Density in right upper lung field
Lobar density Loss of ascending aorta
silhouette No shift of mediastinum Transverse fissure not
significantly shifted Air bronchogram
PLEURAL EFFUSION Fluid accumulates in the pleural space. Radiological criteria are: Increased Density In dependent portion
Costophrenic angle in PA view Along sides in lateral decubitus position Along posteriorly in supine position, giving diffuse
haziness on the side of effusion Blunting of costophrenic angle Lack of identifiable diaphragm (silhouette sign principle).
The silhouette sign loss of an interface by adjacent disease and
permits localization of a lesion on a film by studying the diaphragm, cardiac and aortic outlines.
if the border is retained -the abnormality is superimposed, the lesion must he lying either anterior or posterior.
PLEURAL EFFUSION Homogenous density Meniscus maximum in
axilla Loss of cardiophrenic
angle Loss of diaphragmatic
and right cardiac silhouette
MASSIVE PLEURAL EFFUSION
Massive Shift of
mediastinum
LOCULATED PLEURAL EFFUSION
Homogenous density Loculated Loss of cardiophrenic
angle Loss of lateral portion
of diaphragmatic silhouette
ATELECTASIS loss of air in the alveoli; alveoli devoid of air
Increased density, Signs indicating loss of lung volume Types of Atelectasis:
Resorptive Atelectasis Relaxation Atelectasis Adhesive Atelectasis Cicatricial Atelectasis Round Atelectasis
SIGNS OF ATELECTASISGeneralized Shift of mediastinum Elevation of diaphragm Drooping of shoulder. Crowding of ribs Movement of Fissures
movement of oblique fissures. Forward movement - LUL atelectasis. Backward movement - lower lobe atelectasis. Movement of transverse fissure on PA film.
Movement of Hilum
Cont…
Compensatory Hyperinflation Alterations in Proportion of Left and Right
Lung Hemithorax Asymmetry
ATELECTASIS RIGHT LUNG Homogenous density
right hemithorax Mediastinal shift to right Right hemithorax
smaller Right heart and
diaphragmatic silhouette are not identifiable
LEFT LOWER LOBE ATELECTASIS
Inhomogeneous cardiac density
Left hilum pulled down
Non-visualization of left diaphragm
Triangular retrocardiac atelectatic LLL
Rt UL COLLAPSE
RT MID LOBE
FIBROSIS
Diffuse haziness Apical cap thickening Blunting of costophrenic angle No shift of fluid in lateral decubitus Loss of lung volume Lines not corresponding to fissures
PLEURAL FIROSIS Small right hemithorax Diffuse haziness Tracheal shift to right Blunted costophrenic
angle Lines not corresponding
to fissures
TUBERCULOSIS
LUL cavities RUL infiltrate Bilateral upper
lobe disease
TUERCULOSIS LUL cavity Cavity behind
clavicle - note increased density of clavicle in the region over lying cavity
Pleural effusion on right
Fungal ball
MILIARY TUBERCULOSIS Interstitial nodules
Uniform size Sharper edges
PNEUMOTHORAX Air (black) in pleural space. With No lung
markings Recognition of atelectatic lung (lung margin). Shift of mediastinum to the opposite side. Larger hemithorax. Opposite lung - vascular markings prominent.
PNEUMOTHORAX No vascular markings
on right No shift of mediastinum
to left Deep sulcus Atelectatic right lung Increased haziness on
left: Diversion of entire cardiac output
Small fluid level near costophrenic angle: Hydro pneumothorax
TENSION PNEUMOTHORAX No vascular
markings on right Shift of mediastinum
to left Deep sulcus Atelectatic right lung Increased haziness
on left: Diversion of entire cardiac output
HYDROPNEUMOTHORAX Air in pleural cavity Lung margin visible Bilateral fluid level:
Any time you see a horizontal fluid level, it means that there is air and fluid in the pleural space
LUNG CANCER Squamous cell
Large mass Cavitation
Atelectasis with hilar mass Lympadenopathy
Large cell Large mass
Adenocarcinoma Solitary pulmonary nodule
Small cell Insignificant lung lesion Massive mediastinal adenopathy
Alveolar cell Solitary pulmonary nodule Pneumonic Multicentric
Pancoast tumor Apical shadow Posterior rib destruction Drooping of shoulder / Brachial plexus
ALVEOLAR CELL CARCINOMA
Alveolar Cell Carcinoma / Solitary Pulmonary Nodule
LUL anterior segment lesion
Round with irregular margins
Air bronchogram
PANCOAST TUMOUR Right apical mass Cavitating mass Para tracheal nodes 2nd rib destruction Calcified nodes
(silicosis)
LARGE CELL CANCER
Large Cell Cancer Mass RUL
LUNG MASSMass Round or oval Sharp margin Homogenous No respect for anatomy Lung Cancer: Large cell
LUNG ABSCESS
Lung Abscess
Bilateral Multiple Fluid level
LUNG ABSCESS
Lung Abscess Anterior segment of
LUL Atypical location for
aspiration lung abscess Thick wall Fluid level
PULMOARY EDEMA
Pulmonary EdemaAcute Diffuse Alveolar
Bilateral Diffuse Butterfly pattern Soft fluffy lesions Coalescing Air bronchogram
EMPHYSEMAAlpha 1 Anti-Trypsin
Deficiency Hyperinflation Hyperlucency Low set flat diaphragm Vertical heart Pre and infra cardiac lungs Barrel shape Emphysema Avascular zones Cephalization of upper lung
fields is not evident Predominant basal
involvement (not evident)
SOME D/D
MULTIPLE NODULES OR MASS >3 CM
Mets/Carcinoma/Lymphoma TB/granuloma Wegeners Rheumatoid nodules/Round pneumonia Fungal Sarcoid Septic pulmonary emboli
COIN LESION <3 CM
Carcinoma/Congenital Hamartoma/Hematoma AVM/Abscess Neoplasm–mets Granuoma TB pneumonia
CAVITY
Carcinoma-SCC Abscess-fungal/bacterial/TB Vascular-septic emboli Inflammatory-rheumatoid nodule Trauma-resolving contusion Young-bronchogenic cyst
UNILATERAL HYPERLUCENT LUNG
Poland syndrome/Pneumothorax Oligemia/Obstruction (PE) Emphysema Mastectomy Swyer James
Emphysema
Anterior Mediastinal Masses
1. Thymoma 2. Teratoma 3. Substernal thyroid 4. Lymphoma
Opacified Hemithorax
1. Atelectasis 2. Pleural effusion 3. Pneumonia 4. Post-pneumonectomy/ agenesis
Large Cavitary Lung Lesions
1. Abscess 2. Carcinoma 3. TB
Bronchogenic Carcinoma
Upper Lobe Disease
1. TB (2° TB) 2. Silicosis 3. Eosinophilic granuloma
Micronodular Lung Disease 1. Mets 2. Sarcoid 3. Pneumoconiosis 4. Miliary TB
Micronodular Lung Disease- Sarcoid
Small Cavitary Lung Lesions 1. Septic emboli 2. Rheumatoid nodules 3. Squamous or transitional cell mets 4. Wegener’s Granulomatosis
Multiple Lung Nodules 1. Mets 2. Wegener’s granulomatosis 3. Rheumatoid nodules 4. AVMs 5. Septic emboli
Pulmonary Interstitial Edema 1. CHF 2. Lymphangitic spread 3. Allergic reaction
CHF
Unilateral Hyperlucent Lung 1. Mcleod’s syndrome 2. Pulmonary embolism 3. Pneumothorax 4. Obstructive/ compensatory emphysema
p/o FB
Cavitating Pneumonia 1. Staph 2. Strep 3. TB 4. Gram negative (Klebsiella)
Staph
Middle Mediastinal Masses 1. Lymphadenopathy 2. Aneurysms 3. Esophageal duplication 4. Bronchogenic cysts
Bronchogenic cysts
Hilar Adenopathy 1. Sarcoid 2. TB 3. Lymphoma 4. Bronchogenic ca 5. Mets
Sarcoid
Cavities Containing Masses 1. Aspergillosis 2. Cavitating bronchogenic ca 3 Tuberculosis 4 Hydatid cyst
Aspergillosis
Solitary Pulmonary Nodule 1. Bronchogenic ca 2. Hamartoma 3. Histoplasmoma 4. TB granuloma 5. Bronchial adenoma 6. Solitary met 7. Round pneumonia 8. Rounded atelectasis
Hamartoma
Pleural Effusion
1. CHF
2. Mets
3. Pancreatitis
4. Pulmonary embolism
5. Trauma
6. Empyema
7. Collagen vascular
8. Ovarian tumor (Meig’s Syndrome)
9. Chylothorax
CCF
Left-sided Pleural Effusion 1. Dissecting aortic aneurysm 2. Pancreatitis 3. Distal thoracic duct rupture 4. Esophageal pathology
Dissecting aortic aneurysm
Posterior Mediastinal Masses 1. Neurogenic tumors 2. Lymphadenopathy 3. Extramedullary hematopoesis 4. SPINAL PATHOLOGY 5. DIAPHRAGMATIC HERNIA
Lung Disease & Rib Destruction 1. Bronchogenic ca, i.e Pancoast tumor 2. Actinomycosis 3. Blastomycosis 4. Multiple myeloma
Unilateral Pulmonary Edema 1. Aspiration 2. Disease in other lung, e.g. COPD 3. Postural 4. Rapid expansion of PTX
Unilateral Pulmonary Edema
Reverse “Pulmonary Edema” 1. Eosinophilic lung disease, e.g. Loeffler’s 2. Sarcoid 3. Pulmonary contusions
DIAGNOSIS PLEASE
RT ML CONSOLIDATION
CANNON BALL METZ
ABSCESS
LT UL CONSLIDATION
BRONCHIECTASIS
OS METZ
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